Here, we have tried to put some general information about preparation for both children and adults before Hypospadias repair surgery. More detailed and specific information will be provided by the hypospadias expert surgeon in clinic before admission.
Instructions for Children undergoing Hypospadias surgery
Examination and tests before Hypospadias Surgery:
- History and examination: A thorough history is taken for any evidence of infection, other illness and any familial disorders. A pediatrician consult is often taken for a systemic examination. If the child has infection at any other site in body such as cold, cough, fever, diarrhea, skin infection – it is better to postpone the surgery till the infection is clear. Family history is taken for any bleeding disorder or any drug allergies.
- Pre-operative fitness tests: A complete blood count and a urine test is done to check for body parameters. Viral markers for HIV, Hepatitis are done as a routine pre-operative norm. Chest xray and bleeding/ coagulation tests are no longer recommended routinely before elective surgery if the chest examination is normal and there is no family or other history of excessive bleeding.
If the examination and the tests are normal, then hypospadias surgeon and family can fix up a date for hypospadias operation. If the surgery date is far out, we prefer to conduct another review in person or via email one week before surgery to ascertain that child is fit for hypospadias surgery. Sometimes the parents and families are travelling from a long distance away from within India or other countries, then we try to conduct a phone call one week before the hypospadias repair. We try to keep all hypospadias operation in the first half of the day especially for small babies. This ensures that the staff is in the best of their spirits and best of their energy.
- Empty stomach before surgery: The child needs to be empty stomach for atleast 4 hours for breast milk and 6 hours for other milk/ solid foods/ breads on the day of surgery before surgery. This is a mandatory safety precaution to prevent vomiting during anesthesia. Keeping a 6 months or a one year old child hungry for 4 hours is not an easy task. Infact some of the parents are more worried about keeping a young child hungry than the actual surgery but this is something which is non-negotiable. Often we give the child light sedative syrup 1-2 hours before surgery to help the baby sleep.
- Bathing: The child can be given a bath on the morning of hypospadias repair operation as it will be difficult to give a formal head to toe bath for next 5-7 days after surgery.
- Potty care & constipation: Some of the children may be a little constipated, we advise parents to give a glycerine suppository or a laxative the night before so that the child passes stools and has an empty bowel. Post hypospadias surgery, local pain can often worsen constipation. Hence, do tell your doctor beforehand so that a mild laxative can be prescribed at tie of discharge.
- Admission to hospital: In a hospital with daycare facility, we prefer to admit the child for hypospadias surgery early morning at 6:30am -7am. If the parents live farther away from the hospital or the hospital doesn’t have a daycare facility, we like to admit the children the night before surgery. At Hypospadias foundation in Navi Mumbai, India we mostly admit the children in the morning of the surgery itself unless the parents live more than 50km away or do not have a means of traveling early in morning.
- Consent before anesthesia and surgery: Before hypospadias surgery is started, family has to fill up an anesthesia and a surgery consent form which is quite detailed in general. Sometimes the parents get alarmed on seeing the form. But please feel free to ask us about any doubts which you have. We always have the best of intentions and make all efforts to get your baby back home safely after hypospadias surgery.
- Hospital Clothes: Children are provided and changed into hospital clothes appropriate for their age on the morning of hypospadias surgery. Team and parents must make sure that the iv canula is inserted after changing of clothes else with the canula and splint attached, it is difficult to change clothes.
- Sedation before surgery: If the child is irritable while staying hungry we either advise a pacifier or a light sedative syrup till the time of anesthesia.
- Induction and pre medication for anesthesia: Crying child is not a good sight just before hypospadias surgery for the parents or the hypospadias doctor. If the child has an iv line, anesthesia team often administers a small dose of premedication to help sedate (make the child sleep) the child before shifting to operation theatre. We must understand that getting the child with hypospadias fully cured is a team effort and it needs devotion and patience from both the family as well the surgical team. We at Hypospadias Foundation are committed towards making the whole hypospadias treatment experience seamless, less bothersome, more baby friendly and easy for the families. This also translates into better results stemming from deep interest and commitment to children and adults with hypospadias.
Instructions for adults (over 15 years) undergoing Hypospadias surgery operation
For adults undergoing either primary or failed hypospadias repair surgery, while some of the instructions remain the same, there are some differences as well.
Examination and tests before Adult Hypospadias Surgery:
If the examination and the tests are normal, then hypospadias surgeon and family can fix up a date for hypospadias operation.
- History and examination:A thorough history is taken for any evidence of infection, other illness and any familial disorders. A physician consult is often taken for a systemic examination. If the adult patient has infection at any other site in body such as cold, cough, fever, diarrhea, skin infection – it is better to postpone the surgery till the infection is clear. Family history is taken for any bleeding disorder or any drug allergies.
- Pre-operative fitness tests: A complete blood count and a urine test is done to check for body parameters. A fasting blood sugar, chext xray and ECG is done to ensure good respiratory and cardiac status. Viral markers for HIV, Hepatitis are done as a routine pre-operative norm.
- Empty stomach before surgery: The patient needs to be empty stomach for atleast 6 hours before hypospadias surgery. This is a mandatory safety precaution to prevent vomiting during anesthesia.
- Bathing: The patient can have a bath on the morning of hypospadias repair operation as it will be difficult to have a formal head to toe bath for next 5-7 days after surgery.
- Admission to hospital: In a hospital with daycare facility, we prefer to admit the adults for hypospadias surgery early morning at 6:30am -7am. If the patient far away or the hospital doesn’t have a daycare facility, we like to admit the patients one the night before surgery.
- Consent before anesthesia and surgery: Before hypospadias surgery is started, patient has to fill up an anesthesia and a surgery consent form which is quite detailed in general. Please feel free to ask us about any doubts which you have.
- Hospital Clothes: Adult patients are provided hospital clothes on the morning of hypospadias surgery. We ensure that the iv canula is inserted after changing of clothes else it is difficult to change clothes.
- Induction and pre medication for anesthesia: A small dose of premedication is given to relieve the anxiety before shifting to operation theatre.